下肢短潜伏期体感诱发电位和F波对糖尿病近端神经病的诊断价值

目的 探讨下肢短潜伏期体感诱发电位(SLSEP)和F波检测在糖尿病近端神经病变的诊断意义.方法 排除脑卒中、腰颈椎病及其他疾病引起的神经-肌肉疾病,对92例2型糖尿病患者:有神经病变体征而神经传导检测正常(Ⅰ组)32例、无神经病变体征神经传导检测正常(Ⅱ组)30例和神经传导异常(Ⅲ组)30例,与30名健康人行下肢SLSEP和F波测定.结果 胫神经SLSEP和F波各参数总异常率以Ⅰ组有神经病变体征肢体亚组(n=43)比例最高97.7%(42/43)],Ⅰ组Fdur、N13传导速度(CV)、N24CV、N13-N24CV、N9-N24CV平均值与对照组比较差异均有统计学意义(g值分别:5.887和6.780、-4.568和-5.062、-6.799和-6.905、-5.978和-5.609、-5.433和-5.190;均P＜0.01);Ⅱ组Fdur和N13-N24CV异常肢体率25.0%(15/60),23.3%(14/60)]与对照组0,1. 7%(1/60)]比较差异有统计学意义(x2值分别:17.143、12.876,均P=0.0050);Ⅲ组各参数异常肢体率与对照组比较,除N9-N24CV、N13波幅及N24波幅外,差异均有统计学意义,其中N9CV异常率最高76.7%(46/60)].结论 SLSEP可以提供感觉纤维近端信息;SLSEP和F波联合使用可以提高糖尿病近端神经病变的诊断率,对有周围神经损害症状而常规神经传导速度测定正常的糖尿病患者其诊断意义尤为显著.

Diagnostic value of lower limber Short-latency somatosensory evoked potential and F wave in proximal diabetic neuropathy

Objective To explore the diagnostic value of tibial nerve short-latency somatosensory evoked potential( SLSEP)and F wave in proximal diabetic neuropathy.Methods Excluding stroke,waist cervical vertebra sickness and nerve-muscle diseases caused by other diseases,there were clinical signs of neuropathy but normal nerve conduction EMG(Ⅰ group)32 cases,there weren't clinical signs of neuropathy normal nerve conduction EMG(Ⅱ group)30 cases and abnormal nerve conduction EMG(Ⅲgroup)30 cases.Tibial nerve SLSEP and F wave were measured in 92 patients and 30 normal persons.Results The highest whole abnormality rate of tibial nerve SLSEP's and F wave's all parameters was the sub-group (there were neuropathy symptom lower limbs n=43)of Ⅰ group(97.7% (42/43)).In Ⅰ group Fdur,NI3CV,N24CV, N13-N24CV,N9-N24CV were significantly different from the control group (q value:5.887 and 6.780,-4.568 and-5.062,-6.799 and -6.905,-5.978 and -5.609,-5.433 and -5.190, P＜0.01);The abnormality rate of Fdur and N13-N24CV (25.0%(15/60),23.3% (14/60))in Ⅱgroup were significantly different from the control group (0,1.7%(1/60))also (x2=17.143,12.876, both P=0.0050).In Ⅲ group,except for N9-N24CV,N13 and N24 wave amplitude other parameters'abnormality rates were significantly different from the control group,and the abnormality rate of N9CV was the highest (76.7%(46/60)).Conclusion(1)SLSEP can provide information of proximal sensory nerve segment.(2)SLSEP and F wave can improve the diagnosis rate of proximal diabetic neuropathy,and the diagnostic value is particularly significant to the diabetes patients who have clinical signs of neuropathy but normal nerve conduction EMG.